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    Antidepressant prescribing in Australian primary care: time to reevaluate

    Katharine A Wallis, Anna King and Joanna Moncrieff
    Med J Aust || doi: 10.5694/mja2.52645
    Published online: 5 May 2025

    Around one in seven Australians is now taking antidepressants (3.9 million people, 14%),1 and the prevalence of use is rising.2,3 Two antidepressants, sertraline and escitalopram, are now in the top ten drugs by defined daily dose per 1000 population per day.4 In Australia, women are prescribed antidepressants at 1.5 times the rate of men, and older people (aged ≥ 65 years) are twice as likely to be prescribed antidepressants as younger people (aged < 65 years).2,5 Around 26% of people aged 75 years or older are taking antidepressants.2 Most psychological distress or mental illness is managed in primary care, and antidepressant prescribing is overwhelmingly in primary care, with general practitioners prescribing 92% of antidepressants in Australia.1

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    • 1 University of Queensland, Brisbane, QLD
    • 2 University College London, London, United Kingdom


    Correspondence: k.wallis@uq.edu.au


    Open access:

    Open access publishing facilitated by The University of Queensland, as part of the Wiley ‐ The University of Queensland agreement via the Council of Australian University Librarians.

    Competing interests:

    Katharine Wallis received funding from the Australian Medical Research Future Fund (MRFF) and the National Health and Medical Research Council (NHMRC) to lead the RELEASE (Redressing Long‐term Antidepressant Use) trial. Anna King is a member of the MRFF and NHMRC funded RELEASE trial Lived Experience Advisory Group. Joanna Moncrieff is a co‐investigator on the MRFF and NHMRC funded RELEASE trial, she has been a co‐investigator on a study of antidepressant discontinuation funded by the United Kingdom's National Institute for Health and care Research, she receives modest royalties from books about psychiatric drugs, and she is co‐chair of the Critical Psychiatry Network.

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      The costs and benefits of a prison needle and syringe program in Australia, 2025–30: a modelling study

      Farah Houdroge, Samantha Colledge‐Frisby, Nadine Kronfli, Rebecca J Winter, Joanne Carson, Mark Stoove and Nick Scott
      Med J Aust || doi: 10.5694/mja2.52640
      Published online: 21 April 2025

      Abstract

      Objectives: To estimate and compare the costs and benefits of introducing a prison needle and syringe program in all Australian prisons.

      Study design: Stochastic compartmental modelling study.

      Setting: All Australian prisons, 1 January 2010 to 31 December 2030.

      Intervention: Introduction of a prison needle and syringe program in all Australian prisons during 1 January 2025 – 1 January 2027, with the aim of covering 50% of people who inject drugs in prison by 1 January 2030.

      Main outcome measures: Projected new hepatitis C virus (HCV) infections and hospitalisations with injection‐related bacterial and fungal infections in prisons, with and without the needle and syringe program; costs of the program; savings in treatment costs for HCV and injection‐related bacterial and fungal infections; benefit–cost ratio of the program.

      Results: In the base scenario (no prison needle and syringe program), the projected number of new HCV infections during 2025–2030 was 2932 (uncertainty interval [UI], 2394–3507) and the projected number of hospitalisations with injection‐related bacterial and fungal infections was 3110 (UI, 2596–3654). With the prison needle and syringe program, it was projected that 894 (UI 880–912) new HCV infections (30%; UI, 26–37%) and 522 (UI, 509–532) hospitalisations with injection‐related bacterial and fungal infections (17%; UI, 15–20%) would be averted; the incidence of new HCV infections would be reduced from 3.1 (UI, 2.5–3.7) to 1.3 (UI, 1.0–1.7) per 100 person‐years among people who inject drugs in prison. The estimated cost of the program was $12.2 million (UI, $7.6–22.2 million), and the saved care costs for HCV and injection‐related infections were $31.7 million (UI, $29.3–34.6 million), yielding a benefit–cost ratio of 2.6 (UI, 1.4–4.1). The benefit–cost ratio was also greater than one for scenarios in which the assumptions and base values for several parameters were varied.

      Conclusions: Each dollar spent on a needle and syringe program in Australian prisons could save $2.60 in treatment costs for HCV and other injection‐related infections.

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      • 1 The Burnet Institute, Melbourne, VIC
      • 2 National Drug Research Institute, Perth, WA
      • 3 McGill University Health Centre, Montreal, Canada
      • 4 Centre for Outcomes Research and Evaluation Research, Institute of the McGill University Health Centre, Montreal, Canada
      • 5 St Vincent's Hospital Melbourne, Melbourne, VIC
      • 6 The Kirby Institute, University of New South Wales, Sydney, NSW
      • 7 Monash University, Melbourne, VIC



      Data Sharing:

      This study did not generate original data.

      Acknowledgements: 

      We thank the SToP‐C study group (Supporting Information) for contributing data for some model parameters.

      Competing interests:

      Nadine Kronfli has received research funding from Gilead Sciences, AbbVie, and ViiV Healthcare, advisory fees from Gilead Sciences, ViiV Healthcare, Merck, and AbbVie, and speaker fees from Gilead Sciences, AbbVie, and Merck, all unrelated to this study. Mark Stoové has received investigator‐initiated research funding from Gilead Sciences and AbbVie and consultant fees from Gilead Sciences for activities unrelated to this study. Rebecca Winter has received investigator‐initiated research funding from Gilead Sciences unrelated to this study.

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        Geographic remoteness‐based differences in in‐hospital mortality among people admitted to NSW public hospitals with heart failure, 2002–21: a retrospective observational cohort study

        Imants Rubenis, Gregory Harvey, Karice Hyun, Vincent Chow, Leonard Kritharides, Andrew P Sindone, David B Brieger and Austin CC Ng
        Med J Aust 2025; 222 (7): . || doi: 10.5694/mja2.52635
        Published online: 21 April 2025

        Abstract

        Objective: To examine associations between remoteness of region of residence and in‐hospital mortality for people admitted to hospital with heart failure in New South Wales during 2002–21.

        Study design: Retrospective observational cohort study; analysis of New South Wales Admitted Patient Data Collection data.

        Setting, participants: Adult (16 years or older) NSW residents admitted with heart failure to NSW public hospitals, 1 January 2002 – 30 September 2021. Only first admissions with heart failure during the study period were included.

        Main outcome measures: In‐hospital mortality, by remoteness of residence (Australian Statistical Geography Standard), adjusted for age (with respect to median), sex, socio‐economic status (Index of Relative Socioeconomic Advantage and Disadvantage [IRSAD], with respect to median), other diagnoses, hospital length of stay, and calendar year of admission (by 4‐year group).

        Results: We included 154 853 admissions with heart failure; 99 687 people lived in metropolitan areas (64.4%), 41 953 in inner regional areas (27.1%), and 13 213 in outer regional/remote/very remote areas (8.5%). The median age at admission was 80.3 years (interquartile range [IQR], 71.2–86.8 years), and 78 591 patients were men (50.8%). The median IRSAD score was highest for people from metropolitan areas (metropolitan: 1000; IQR, 940–1064; inner regional: 934; IQR, 924–981; outer regional/remote/very remote areas: 930; IQR, 905–936). During 2002–21, 9621 people (6.2%) died in hospital; the proportion was 8.0% in 2002, 4.9% in 2021. In‐hospital all‐cause mortality was lower during 2018–21 than during 2002–2005 (adjusted odds ratio [aOR], 0.52; 95% confidence interval [CI], 0.49–0.56); the decline was similar for all three remoteness categories. Compared with people from metropolitan areas, the odds of in‐hospital death during 2002–21 were higher for people from inner regional (aOR, 1.12; 95% CI, 1.07–1.17) or outer regional/remote/very remote areas (aOR, 1.35; 95% CI, 1.25–1.45).

        Conclusion: In‐hospital mortality during heart failure admissions to public hospitals declined across NSW during 2002–21. However, it was higher among people living in regional and remote areas than for people from metropolitan areas. The reasons for the difference in in‐hospital mortality should be investigated.

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        • 1 Concord Repatriation General Hospital, Sydney, NSW
        • 2 The University of Sydney, Sydney, NSW
        • 3 ANZAC Research Institute, Sydney, NSW


        Correspondence: imants.rubenis@sydney.edu.au


        Open access:

        Open access publishing facilitated by the University of Sydney, as part of the Wiley – the University of Sydney agreement via the Council of Australian University Librarians.


        Data Sharing:

        The NSW Population and Health Services Research Ethics Committee (PHSREC) prohibits authors from making the minimal data set publicly available. Interested researchers may contact the ethics coordinator (ethics@cancerinstitute.org.au) to seek permission to access the data; data will then be made available upon request to interested researchers who receive approval from the NSW PHSREC.

        Competing interests:

        No relevant disclosures.

        • 1. Australian Institute of Health and Welfare. Heart, stroke and vascular disease: Australian facts (cat. no. CVD 92). Updated 12 Dec 2024. https://www.aihw.gov.au/reports/heart‐stroke‐vascular‐diseases/hsvd‐facts/contents/about (viewed Dec 2024).
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        • 3. Baxter J, Gray M, Hayes A; Australian Institute of Family Studies. Families in regional, rural and remote Australia. Mar 2011. https://aifs.gov.au/research/research‐reports/families‐regional‐rural‐and‐remote‐australia (viewed Dec 2023).
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        • 5. Jong P, Gong Y, Liu PP, et al. Care and outcomes of patients newly hospitalized for heart failure in the community treated by cardiologists compared with other specialists. Circulation 2003; 15: 184‐191.
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        • 15. NHFA CSANZ Heart Failure Guidelines Working Group; Atherton JJ, Sindone A, Pasquale CGD, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Guidelines for the prevention, detection, and management of heart failure in Australia 2018. Heart Lung Circ 2018; 27: 1123‐1208.
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        • 20. Vijayarajan V, Kritharides L, Brieger D, et al. Sex differences in rates of permanent pacemaker implantation and in‐hospital complications: a statewide cohort study of over 7 million persons from 2009–2018. PLoS One 2022; 17: e0272305.
        • 21. Von Elm E Altman D, Egger M, et al; STROBE initiative. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370: 1453‐1457.
        • 22. Australian Bureau of Statistics. Index of Relative Socio‐economic Advantage and Disadvantage (IRSAD). In: Socio‐Economic Indexes for Areas (SEIFA); 2021. 27 Apr 2023. https://www.abs.gov.au/statistics/people/people‐and‐communities/socio‐economic‐indexes‐areas‐seifa‐australia/latest‐release#index‐of‐relative‐socio‐economic‐advantage‐and‐disadvantage‐irsad‐ (viewed Dec 2023).
        • 23. Australian Bureau of Statistics. Statistical Area Level 2. Australian Statistical Geography Standard (ASGS) edition 3, July 2021 – June 2026. 20 July 2021. https://www.abs.gov.au/statistics/standards/australian‐statistical‐geography‐standard‐asgs‐edition‐3/jul2021‐jun2026/main‐structure‐and‐greater‐capital‐city‐statistical‐areas/statistical‐area‐level‐2 (viewed Dec 2023).
        • 24. Al‐Omary MS, Davies AJ, Evans TJ, et al. Mortality and readmission following hospitalisation for heart failure in Australia: a systematic review and meta‐analysis. Heart Lung Circ 2018; 27: 917‐927.
        • 25. Newton PJ, Davidson PM, Reid CM, et al. Acute heart failure admissions in New South Wales and the Australian Capital Territory: the NSW HF Snapshot Study. Med J 2016; 204: 113. https://www.mja.com.au/journal/2016/204/3/acute‐heart‐failure‐admissions‐new‐south‐wales‐and‐australian‐capital‐territory
        • 26. Al‐Omary MS, Khan AA, Davies AJ, et al. Outcomes following heart failure hospitalization in a regional Australian setting between 2005 and 2014. ESC Heart Fail 2018; 5: 271‐278.
        • 27. Chan RK, Dinh DT, Hare DL, et al; VCOR‐HF Investigators. Management of acute decompensated heart failure in rural versus metropolitan settings: an Australian experience. Heart Lung Circ 2022; 31: 491‐498.
        • 28. Tamaki Y, Yaku H, Morimoto T, et al; KCHF Study Investigators. Lower in‐hospital mortality with beta‐blocker use at admission in patients with acute decompensated heart failure. J Am Heart Assoc 2021; 10: e020012.
        • 29. Koh HB, Quah WJ, Tey S, et al. Predictors of in‐hospital mortality due to heart failure hospitalisation and trends of guideline‐directed medical therapy usage [abstract: European Society of Cardiology congress, Barcelona, 26–29 August 2022]. Eur Heart J 2022; 43 (Suppl 2): ehac544.1074.
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          Early cardiovascular collapse after envenoming by snakes in Australia, 2005–2020: an observational study (ASP‐31)

          Geoffrey K Isbister, Katherine Z Isoardi, Angela L Chiew, Shane Jenkins and Nicholas A Buckley
          Med J Aust 2025; 222 (6): . || doi: 10.5694/mja2.52622
          Published online: 7 April 2025

          Abstract

          Objectives: To investigate the frequency, timing, and characteristics of cardiovascular collapse after snakebite in Australia, and the complications of collapse following envenoming.

          Study design: Observational study; analysis of prospectively collected demographic and clinical data.

          Setting, participants: People with confirmed snake envenoming recruited to the Australian Snakebite Project at one of 200 participating Australian hospitals, 1 July 2005 – 30 June 2020.

          Main outcome measures: Time from snakebite to collapse; post‐collapse complications (cardiac arrest, seizures, death).

          Results: Of 1259 envenomed people, 157 (12%) collapsed within 24 hours of the snakebite; venom‐induced consumption coagulopathy (VICC) was determined in all 156 people for whom coagulation testing could be performed. The exact time between bite and collapse was known for 149 people (median, 20 min; interquartile range, 15–30 min; range, 5–115 min); the time exceeded 60 minutes for only two people, each after releasing tight bandages 60 minutes after the bite. The collapse preceded hospital arrival in 132 cases (84%). Brown snake (Pseudonaja spp.) envenoming was the leading cause of collapse (103 cases, 66%). Forty‐two collapses (27%) were followed by cardiac arrest, 49 (31%) by seizures (33 without cardiac arrest), and five by apnoea; collapse was associated with hypotension in all 24 people whose blood pressure could be measured at or close to the time of collapse. Twenty‐five people who collapsed died (16%), and seven of the envenomed people who did not collapse (0.6%; difference: 15 percentage points; 95% confidence interval, 8–21 percentage points). The deaths of 21 of the 25 people who collapsed were immediately associated with the cardiac arrest that followed the collapse; three people who did not have cardiac arrests died later of intracranial haemorrhage, and one of hyperthermia. The proportion of people who had collapsed before reaching hospital was larger for people who died of post‐collapse cardiac arrest (13 of 21, 62%) than for those who survived (6 of 21, 28%).

          Conclusion: Collapse after Australian snake envenoming almost always occurred within 60 minutes of the bite, was always accompanied by VICC, and most frequently followed brown snake bites. Poorer outcomes, including cardiac arrest, seizures, and death, were more frequent for people who collapsed than for those who did not. Outcomes for people who collapsed before medical care arrived were poorer than for those who collapsed in hospital or in an ambulance.

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          • 1 The University of Sydney, Sydney, NSW
          • 2 The University of Newcastle, Newcastle, NSW
          • 3 NSW Poisons Information Centre, Children's Hospital at Westmead, Sydney, NSW
          • 4 Princess Alexandra Hospital, Brisbane, QLD
          • 5 The University of Queensland, Brisbane, QLD
          • 6 Prince of Wales Hospital and Community Health Services, Sydney, NSW



          Open access:

          Open access publishing facilitated by The University of Newcastle, as part of the Wiley – the University of Newcastle agreement via the Council of Australian University Librarians.

          Acknowledgements: 

          We acknowledge Kylie Tape (University of Newcastle) for data collection and data entry for the Australian Snakebite Project.

          Competing interests:

          No relevant disclosures.

          • 1. GBD 2019 Snakebite Envenomation Collaborators. Global mortality of snakebite envenoming between 1990 and 2019. Nat Commun 2022; 13: 6160.
          • 2. Ralph R, Faiz MA, Sharma SK, et al. Managing snakebite. BMJ 2022; 376: e057926.
          • 3. Johnston CI, Ryan NM, Page CB, et al. The Australian Snakebite Project, 2005–2015 (ASP‐20). Med J Aust 2017; 207: 119‐125. https://www.mja.com.au/journal/2017/207/3/australian‐snakebite‐project‐2005‐2015‐asp‐20
          • 4. Isbister GK, Brown SG, Page CB, et al. Snakebite in Australia: a practical approach to diagnosis and treatment. Med J Aust 2013; 199: 763‐768. https://www.mja.com.au/journal/2013/199/11/snakebite‐australia‐practical‐approach‐diagnosis‐and‐treatment
          • 5. Allen GE, Brown SG, Buckley NA, et al; ASP Investigators. Clinical effects and antivenom dosing in brown snake (Pseudonaja spp.) envenoming: Australian snakebite project (ASP‐14). PLoS One 2012; 7: e53188.
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          • 7. Gan M, O'Leary MA, Brown SG, et al. Envenoming by the rough‐scaled snake (Tropidechis carinatus): a series of confirmed cases. Med J Aust 2009; 191: 183‐186. https://www.mja.com.au/journal/2009/191/3/envenoming‐rough‐scaled‐snake‐tropidechis‐carinatus‐series‐confirmed‐cases
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          • 11. Kakumanu R, Kemp‐Harper BK, Silva A, et al. An in vivo examination of the differences between rapid cardiovascular collapse and prolonged hypotension induced by snake venom. Sci Rep 2019; 9: 20231.
          • 12. Dias L, Rodrigues MA, Rennó AL, et al. Hemodynamic responses to Lachesis muta (South American bushmaster) snake venom in anesthetized rats. Toxicon 2016; 123: 1‐14.
          • 13. Tibballs J, Sutherland SK, Kerr S. Studies on Australian snake venoms, part II: The haematological effects of brown snake (Pseudonaja) species in the dog. Anaesth Intensive Care 1991; 19: 338‐442.
          • 14. Jelinek GA, Smith A, Lynch D, et al. The effect of adjunctive fresh frozen plasma administration on coagulation parameters and survival in a canine model of antivenom‐treated brown snake envenoming. Anaesth Intensive Care 2005; 33: 36‐40.
          • 15. Chaisakul J, Isbister GK, Konstantakopoulos N, et al. In vivo and in vitro cardiovascular effects of Papuan taipan (Oxyuranus scutellatus) venom: exploring “sudden collapse”. Toxicol Lett 2012; 213: 243‐248.
          • 16. Chaisakul J, Isbister GK, Kuruppu S, et al. An examination of cardiovascular collapse induced by eastern brown snake (Pseudonaja textilis) venom. Toxicol Lett 2013; 221: 205‐211.
          • 17. Coroners Court of New South Wales. Inquest into the death of Brent Justin Crough (2018/10493). Date of findings: 7 May 2021. https://coroners.nsw.gov.au/documents/findings/2021/CROUGH_findings_Tamworth.pdf (viewed Feb 2025).
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          • 20. Australian Bureau of Statistics. Australian Statistical Geography Standard (ASGS) edition 3, July 2021 – June 2026. 27 July 2021. https://www.abs.gov.au/statistics/standards/australian‐statistical‐geography‐standard‐asgs‐edition‐3/latest‐release (viewed Feb 2025).

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            Accountability, ambition, and quantifiable action in the carbon emission reduction plans of the ten largest pharmaceutical companies in Australia: a cross‐sectional analysis

            Hayden Burch, Georgia Brown, Oliver Adler, Jason Wong and Kenneth D Winkel
            Med J Aust 2025; 222 (6): . || doi: 10.5694/mja2.52621
            Published online: 7 April 2025

            Abstract

            Objectives: To assess the commitment of the ten largest pharmaceutical companies operating in Australia to achieving net zero emissions by evaluating their accountability metrics, ambitions, and quantifiable actions taken.

            Study design: Cross‐sectional study; analysis of publicly available company reports published during 12 December 2015 – 31 December 2023.

            Setting, participants: Ten largest pharmaceutical companies operating in Australia, defined by total pharmaceutical costs (to patients and Pharmaceutical Benefits Scheme) for PBS‐subsidised medications, as reported in PBS expenditure and prescriptions reports for 2020–21 and 2022–23.

            Main outcome measures: Content analysis of publicly available documents for the ten companies using modified criteria from the PricewaterhouseCoopers Building blocks for net zero transformation framework, with three domains: accountability, ambition, and action; the Carbon Disclosure Project (CDP) grading; the Science Based Targets initiative (SBTi) approval system. We focused on measurement, target setting, and achievement of emission reductions, and ranked the environmental sustainability of companies using a points and colour coding system.

            Results: Three groups could be defined by evidence of their commitment to emissions reductions. The first — companies leading emissions reduction efforts, with SBTi‐approved near term targets, consistent emissions monitoring, well defined commitments, and quantified evidence of action — includes AstraZeneca, Novartis, Johnson & Johnson, Bayer, and Merck & Co. The second group — companies that had made commitments to SBTi‐approved targets but their disclosure records are limited — includes AbbVie and Roche. The third group — without public commitments to achieving net zero emissions, minimal or no SBTi‐approved targets, and minimal disclosure or monitoring of emissions — includes Viatris, Vertex, and Arrotex.

            Conclusions: The ten largest pharmaceutical companies in Australia are moving towards net zero greenhouse gas emissions at different rates. Gaps in standardised reporting processes should be closed, and further qualitative research on industry‐wide environmental sustainability policy and practice is needed.

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            • 1 Melbourne Medical School, the University of Melbourne, Melbourne, VIC
            • 2 Austin Health, Melbourne, VIC
            • 3 New England Local Health District, Newcastle, NSW
            • 4 Melbourne School of Population and Global Health, the University of Melbourne, Melbourne, VIC


            Correspondence: burchh@unimelb.edu.au


            Open access:

            Open access publishing facilitated by The University of Melbourne, as part of the Wiley – the University of Melbourne agreement via the Council of Australian University Librarians.


            Data Sharing:

            We confirm that the data supporting the findings of this study were derived from public domain sources and are available in the article and its supplementary materials.

            Acknowledgements: 

            Open access publishing facilitated by The University of Melbourne, as part of the Wiley – the University of Melbourne agreement via the Council of Australian University Librarians.

            Competing interests:

            All authors are members of Doctors for the Environment Australia.

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              The Fossil Fuel Non‐Proliferation Treaty: what it is, its importance for health, and why Australia should endorse it

              Philomena Colagiuri, Jake TW Williams, Paul J Beggs and Ying Zhang
              Med J Aust 2025; 222 (6): . || doi: 10.5694/mja2.52610
              Published online: 24 March 2025

              Climate change — driven primarily by the extraction and burning of fossil fuels — is profoundly affecting our health. Some impacts are direct and immediate, such as from worsening heatwaves and extreme weather events.1 Others are indirect and more complex, including changes to the social determinants of health and the distribution of infectious diseases, and increased water and food insecurity. The risks associated with climate change are not being felt equally, and it is the most disadvantaged people and countries (who have generally contributed the least to climate change) that are disproportionately exposed and vulnerable.2

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              • 1 University of Sydney, Sydney, NSW
              • 2 Macquarie University, Sydney, NSW


              Correspondence: ying.zhang@sydney.edu.au


              Open access:

              Open access publishing facilitated by The University of Sydney, as part of the Wiley ‐ The University of Sydney agreement via the Council of Australian University Librarians.

              Acknowledgements: 

              We would like to acknowledge the Climate and Health Foundation for providing financial support for the development of this manuscript. The Climate and Health Foundation had no role in the planning, writing or publication of the work.

              Competing interests:

              Philomena Colagiuri received funding from the Climate and Health Foundation for her role as Lancet Countdown Oceania Fellow. The Climate and Health Foundation also provided funding for her to attend COP29 in Baku, Azerbaijan in 2024 (airfare, accommodation, daily stipend). Jake Williams received funding from the Climate and Health Foundation for his role as Lancet Countdown Oceania Fellow. The Climate and Health Foundation also provided funding for him to attend COP29 in Baku, Azerbaijan in 2024. Jake Williams received funding from the Wiser Healthcare Research Collaboration for the 2024 EMCR Seed Grant, and funding from HEAL (Healthy Environments And Lives) National Research Network (National Health and Medical Research Council Grant No. 2008937) for the 2024 Travel Award and 2023 Travel Award. Paul Beggs received funding from the Lancet Countdown for in‐kind support (payment of airfare, accommodation etc.) to attend the Lancet Countdown Annual Meeting, London, 2024. He also received funding from the Climate and Health Foundation for in‐kind support (payment of airfare, accommodation etc.) to attend UNFCCC COP28, Dubai, 2023. Paul Beggs is the Director of Oceania Regional Centre for the Lancet Countdown. Ying Zhang has received funding from the Climate and Health Foundation for in‐kind support (payment of airfare, accommodation etc.) to attend UNFCCC COP28, Dubai, 2023. Ying Zhang is a Co‐Director of Oceania Regional Centre for the Lancet Countdown and is on the Editorial Board for the Journal of Climate Change and Health.

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                The potential of maternal and child health service data in Australia: how lessons from the COVID‐19 pandemic can accelerate data‐informed decision making

                Ashleigh Shipton, Meredith O'Connor, Melissa Wake, Sharon Goldfeld, Helen Lees, Catina Adams, Kristina Edvardsson, Leesa Hooker, Jatender Mohal, Rhiannon M Pilkington and Fiona K Mensah
                Med J Aust || doi: 10.5694/mja2.52630
                Published online: 7 April 2025

                To enable proactive decisions that promote a healthy start to life, our understanding of children's health and development at a population level is only as good as the data we collect and analyse.1 A decade ago, Olver called for improved access and capacity to link data in the Australian context, voiced in the Medical Journal of Australia.2 In the intervening years, there have been varying rates of progress across Australian states and territories. Victoria's routinely collected statewide data documenting children's health and development from pregnancy to school entry, the maternal and child health (MCH) service dataset, is the most comprehensive nationally with the highest population uptake, yet remains unlinked to key health and determinants data and longitudinal cohorts.3 The time to address this is now given increasing policy interest in the first 2000 days (conception to five years of age) demonstrated by the national Early Years Strategy 2024–2034 and the $14 billion rollout of Victoria's Best Start, Best Life reforms.4,5,6

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                • 1 University of Melbourne, Melbourne, VIC
                • 2 Murdoch Children's Research Institute, Melbourne, VIC
                • 3 Royal Children's Hospital, Melbourne, VIC
                • 4 Municipal Association of Victoria, Melbourne, VIC
                • 5 La Trobe University, Melbourne, VIC
                • 6 University of Adelaide, Adelaide, SA


                Correspondence: fmensah@unimelb.edu.au


                Open access:

                Open access publishing facilitated by The University of Melbourne, as part of the Wiley ‐ The University of Melbourne agreement via the Council of Australian University Librarians.

                Competing interests:

                This perspective article was written as part of Ashleigh Shipton's PhD project “The effect of COVID‐19 pandemic and policies on maternal and child health outcomes in the Western Health region of Victoria: a mixed methods study” funded by the University of Melbourne, Royal Australasian College of Physicians and Murdoch Children's Research Institute. The Royal Children's Hospital Melbourne Human Research Ethics Committee approved Ashleigh Shipton's PhD project as above (reference number: 87751). Melissa Wake was funded by the Australian National Health and Medical Research Council (NHMRC) Principal Research Fellowship 1160906. Sharon Goldfeld was funded by NHMRC Practitioner Fellowship 2026263. Ashleigh Shipton, Meredith O'Connor, Melissa Wake, Sharon Goldfeld, Jatender Mohal and Fiona Mensah's research at the Murdoch Children's Research Institute is supported by the Victorian Government's Operational Infrastructure Support Program. Rhiannon Pilkington was supported by NHMRC CTCS (1187489). Leesa Hooker, Kristina Edvardsson, Helen Lees and Catina Adam's in‐kind support is funded by their teaching and research at La Trobe University. Helen Lees receives in‐kind support from the Municipal Association of Victoria as the maternal and child health policy and program lead. Authors acknowledge that project and salary support for projects unrelated to the present manuscript were received from funding bodies including the NHMRC, Medical Research Future Fund, Paul Ramsay Foundation, State Government of Tasmania, Victorian Government, right@home implementation licence, Australian National Research Organisation for Women's Safety, Victorian Department of Social Services, Family Safety Victoria, Channel 7 Children's Research Foundation, South Australian Department of Human Services, Uniting Communities, Junction Australia, and Commissioner for Aboriginal Children and Young People. Authors acknowledge that payment of honoraria unrelated to the present manuscript were received for lectures, presentations and manuscript peer review. The University of Melbourne had no role in planning or writing this article. The other funders had no role in the planning, writing or publication of this article.

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                  Dismantling barriers to research and clinical care for individuals with a vision impairment

                  Eden G Robertson, Kate Hetherington, Meredith Prain, Julia Hall, Leighton Boyd AM, Rosemary Boyd OAM, Emily Shepard, Hollie Feller, Sally Karandrews, Fleur O'Hare, Kanae Yamamoto, Matthew P Simunovic, Robyn V Jamieson, Alan Ma, Lauren Ayton AM and Anai Gonzalez‐Cordero
                  Med J Aust || doi: 10.5694/mja2.52627
                  Published online: 31 March 2025

                  In Australia, little prevalence data around vision impairment exist. However, self‐reported data from the Australian Bureau of Statistics 2017–18 National Health Survey1 suggest that around 800 000 people have a vision impairment or are blind (excluding uncorrected refractive errors).2 The leading cause of vision impairment in working‐age adults are inherited retinal diseases (IRDs)3 — a group of genetic conditions that primarily affect the retina. Other than one particular gene therapy for biallelic RPE65‐associated retinal dystrophy, there are no other clinically available treatments to safely prevent vision loss or restore vision for someone with an IRD.4

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                  • 1 UNSW Sydney, Sydney, NSW
                  • 2 Children's Medical Research Institute, Sydney, NSW
                  • 3 Sydney Children's Hospitals Network – Randwick, Sydney, NSW
                  • 4 Able Australia, Melbourne, VIC
                  • 5 University of Melbourne, Melbourne, VIC
                  • 6 Retina Australia, Melbourne, VIC
                  • 7 UsherKids Australia, Melbourne, VIC
                  • 8 Blind Citizens Australia, Melbourne, VIC
                  • 9 Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC
                  • 10 Sydney, NSW
                  • 11 Save Sight Institute, University of Sydney, Sydney, NSW
                  • 12 Sydney Hospital and Sydney Eye Hospital, Sydney, NSW
                  • 13 Sydney Children's Hospitals Network – Westmead, Sydney, NSW
                  • 14 University of Sydney, Sydney, NSW


                  Correspondence: eden.robertson@unsw.edu.au


                  Open access:

                  Open access publishing facilitated by University of New South Wales, as part of the Wiley – University of New South Wales agreement via the Council of Australian University Librarians.

                  Acknowledgements: 

                  Eden Robertson and Anai Gonzalez‐Cordero are supported by a 2021 Medical Research Future Fund Stem Cell Therapies Mission (APP2016039). Consumers (Meredith Prain, Leighton Boyd, Emily Shepard, Hollie Feller, Sally Karandrews, and Kanae Yamamoto) are also supported by a 2021 Medical Research Future Fund Stem Cell Therapies Mission (APP2016039). Kate Hetherington is supported by the Cancer Institute Translational Program Grant (2021/TPG2112) as well as Luminesce Alliance and the Zero Childhood Cancer National Personalised Medicine Program for children with high risk cancer, a joint initiative of Children's Cancer Institute and Kids Cancer Centre, Sydney Children's Hospital, Randwick.

                  Competing interests:

                  No relevant disclosures.

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                    Physician advocacy, international humanitarian law, and the protection of health care workers in conflict zones

                    Irma Bilgrami, Christopher Guy, Vanessa Carnegie and Sandra Lussier
                    Med J Aust || doi: 10.5694/mja2.52626
                    Published online: 24 March 2025

                    Attacks on health care in conflict zones are increasing, depriving civilians of urgently needed care, putting the lives of patients and health care workers at risk, and contributing to the deterioration in the health of affected populations.1 Health care is protected under international humanitarian law but there are challenges faced with its enforcement. Consequently, we opine that physicians and medical societies have a moral imperative to advocate for the enduring protection of health care workers, patients, and health care infrastructure in conflict zones.

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                    • 1 Western Health, Melbourne, VIC
                    • 2 Alfred Health, Melbourne, VIC
                    • 3 Austin Health, Melbourne, VIC


                    Correspondence: irma.bilgrami@wh.org.au

                    Correspondence: lussier.sandra1@gmail.com

                    Acknowledgements: 

                    The statements and opinions in this manuscript reflect the authors’ views alone and do not represent the official policies or views of our institutions.

                    Competing interests:

                    No relevant disclosures.

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                      Cultural safety, the LGBTQI+ community and international medical graduate training

                      Cindy Towns, Charlene Rapsey and Rhea Liang
                      Med J Aust || doi: 10.5694/mja2.52617
                      Published online: 17 March 2025

                      Culturally safe health care for all people is a requirement for medical practice in Australia and Aotearoa New Zealand.1,2 In both countries, legislation protects the rights of the lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) community. Despite progress toward equality, higher rates of discrimination towards LGBTQI+ communities contribute to double the risk of mental health disorders and increased inequities in health outcomes, such as cardiovascular disease and cancer survivorship, compared with their non‐LGBTQI+ counterparts.3,4,5

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                      • 1 University of Otago, Wellington, Wellington, New Zealand
                      • 2 Capital and Coast District Health Board, Wellington, New Zealand
                      • 3 University of Otago, Dunedin, New Zealand
                      • 4 Robina Hospital, Gold Coast, QLD
                      • 5 Bond University, Gold Coast, QLD


                      Correspondence: cindy.towns@otago.ac.nz


                      Open access:

                      Open access publishing facilitated by University of Otago, as part of the Wiley ‐ University of Otago agreement via the Council of Australian University Librarians.

                      Acknowledgements: 

                      Open access publishing facilitated by University of Otago, as part of the Wiley ‐ University of Otago agreement via the Council of Australian University Librarians.

                      Competing interests:

                      No relevant disclosures.

                      • 1. Health Practitioners Competence Assurance Act 2003.
                      • 2. Medical Board of Australia. Good medical practice: a code of conduct for doctors in Australia. Melbourne: Ahpra, 2020. https://www.medicalboard.gov.au/codes‐guidelines‐policies/code‐of‐conduct.aspx (viewed Feb 2025).
                      • 3. Weideman, BCD and D. McAlpine. State LGBTQ policy environments and the cancer burden in sexual and gender minoritized communities in the United States. Cancer Med 2024; 13: e70097.
                      • 4. Gmelin JOH, De Vries YA, Baams L, et al. Increased risks for mental disorders among LGB individuals: cross‐national evidence from the World Mental Health Surveys. Soc Psychiatry Psychiatr Epidemiol 2022; 57: 2319‐2332.
                      • 5. Veale JF. Transgender‐related stigma and gender minority stress‐related health disparities in Aotearoa New Zealand: hypercholesterolemia, hypertension, myocardial infarction, stroke, diabetes, and general health. Lancet Reg Health West Pac 2023; 39: 100816.
                      • 6. Ayhan CHB, Bilgin H, Uluman OT, et al. A systematic review of the discrimination against sexual and gender minority in health care settings. Int J Health Serv 2020; 50: 44‐61.
                      • 7. Tan KKH, Carroll R, Treharne GJ, et al. “I teach them. I have no choice”: experiences of primary care among transgender people in Aotearoa New Zealand. N Z Med J 2022; 135: 59‐72.
                      • 8. Seelman KL, Colón‐Diaz MJP, LeCroix RH, et al. Transgender noninclusive healthcare and delaying care because of fear: connections to general health and mental health among transgender adults. Transgend Health 2017; 2: 17‐28.
                      • 9. Reisner SL, Hughto JMW, Dunham EE, et al. Legal protections in public accommodations settings: A critical public health issue for transgender and gender‐nonconforming people. Milbank Q 2015; 93: 484‐515.
                      • 10. Treharne GJ, Carroll R, Tan KKH, Veale JF. Supportive interactions with primary care doctors are associated with better mental health among transgender people: results of a nationwide survey in Aotearoa/New Zealand. Fam Pract 2022; 39: 834‐842.
                      • 11. Australian Medical Council. Standards for Assessment and Accreditation of Primary Medical Programs. Canberra: AMC, 2023. https://www.amc.org.au/wp‐content/uploads/2023/08/AMC‐Medical_School_Standards‐FINAL.pdf (viewed Feb 2025).
                      • 12. Walker C. Cultural safety and health equity in medical practice in Aotearoa New Zealand. In: Morris KA, editor. Cole's medical practice in New Zealand. Wellington: Medical Council of New Zealand, 2021. https://www.mcnz.org.nz/assets/standards/08588745c0/Coles‐Medical‐Practice‐in‐New‐Zealand.pdf (viewed Feb 2025).
                      • 13. Medical Council of New Zealand. Statement on cultural safety. Wellington: MCNZ, 2019. https://www.mcnz.org.nz/assets/standards/b71d139dca/Statement‐on‐cultural‐safety.pdf (viewed Feb 2025).
                      • 14. Morris KA, editor. Cole's medical practice in New Zealand. Wellington: Medical Council of New Zealand, 2021. https://www.mcnz.org.nz/assets/standards/08588745c0/Coles‐Medical‐Practice‐in‐New‐Zealand.pdf (viewed Feb 2025).
                      • 15. Human Rights (Sexual Conduct) Act 1994.
                      • 16. Marriage Amendment (Definition and Religious Freedoms) Act 2017.
                      • 17. ILGA World Database. Area 1: Legal frameworks — criminalisation of consensual same‐sex sexual acts. https://database.ilga.org/criminalisation‐consensual‐same‐sex‐sexual‐acts (viewed Feb 2025).
                      • 18. Human Rights Watch. Outlawed: “the love that dare not speak its name”. https://features.hrw.org/features/features/lgbt_laws/ (viewed Feb 2025).
                      • 19. Association of Salaried Medical Specialists Toi Mata Hauora. International medical migration: how can New Zealand compete as specialist shortages intensify? Wellington: ASMS, 2017. https://asms.org.nz/wp‐content/uploads/2022/05/IMG‐Research‐Brief_167359.5.pdf (viewed Feb 2025).
                      • 20. Yeomans ND. Demographics and distribution of Australia's medical immigrant workforce. J Migr Health 2022; 1: 100109.
                      • 21. Medical Council of New Zealand. The New Zealand medical workforce, 2023. Wellington: MCNZ, 2023. https://www.mcnz.org.nz/assets/Publications/Workforce‐Survey/Workforce‐Survey‐Report‐2023.pdf (viewed Feb 2025).
                      • 22. Delahunt JW, Denison HJ, Sim DA, et al. Increasing rates of people identifying as transgender presenting to Endocrine Services in the Wellington region. N Z Med J 2018; 131: 33‐42.
                      • 23. Taylor O, Rapsey CM, Treharne GJ. Sexuality and gender identity teaching within preclinical medical training in New Zealand: content, attitudes and barriers. N Z Med J 2018; 131: 35‐44.
                      • 24. Sanchez AA, Southgate E, Rogers G, Duvivier RJ. Inclusion of lesbian, gay, bisexual, transgender, queer, and intersex health in Australian and New Zealand medical education. LGBT Health 2017; 4: 295‐303.
                      • 25. Cooper RL, Ramesh A, Radix AE, et al. Affirming and inclusive care training for medical students and residents to reduce health disparities experienced by sexual and gender minorities: a systematic review. Transgend Health 2022; 8: 307‐327.
                      • 26. Australian Medical Students Association. Sex and gender equity in the medical curriculum and medical research, 2022. Canberra: AMSA, 2022. https://amsa.org.au/wp‐content/uploads/2023/10/Sex‐and‐Gender‐Equity‐in‐the‐Medical‐Curriculum‐and‐Medical‐Research‐2022.pdf (viewed Feb 2025).
                      • 27. Hanganu B, Ioan BG. The personal and professional impact of patients’ complaints on doctors — a qualitative approach. Int J Environ Res Public Health 2022; 19: 562.

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